Pulmonary embolism in pregnancy

Background

• Also consider V/Q in young females in order to minimize radiation exposure to breast tissue
• Also consider V/Q vs CTPA in pregnant females depending on multiple considerations including the above + radiation burden to fetus

Clinical Features

See Pulmonary Embolism

Workup

If clinical features suggestive of PE and lower extremity swelling then

1. 1. Bilateral LE Ultrasound

1. if Positive-->treat empirically for PE
2. if Negative-->CTA

CT (with shield) vs. V/Q is roughly equilivalent radiation exposure

American Thoracic Society In Pregnancy

• D-dimer is not recommended for excluding PE (weak recommendation, very-low-quality evidence).
• If signs and symptoms of deep venous thrombosis (DVT), first perform bilateral venous compression ultrasound (CUS) of lower extremities, followed by anticoagulation treatment if positive and by further testing if negative (weak recommendation, very-low-quality evidence).
• If no signs and symptoms of DVT, pulmonary vascular imaging should be used over bilateral lower extremity ultrasounds(weak recommendation, very-low-quality evidence).

D-Dimer

• D-Dimer MAY BE used with following limits with very poor evidence
  • 1st trimester: <750 ng/mL (+50% increase from normal lab threshold)
  • 2nd trimester: <1000 ng/mL (+100% from normal)
  • 3rd trimester: <1250 ng/mL (+150% from normal)

Management

• Heparin and Enoxaparin are safe (coumadin is not)

Disposition

Admit

See Also

• Pulmonary Embolism